Female Health Flashcards
(191 cards)
1
Q
What is labour defined as?
A
Onset of regular and painful contractions associated with cervical dilation and descent of the presenting part
2
Q
Signs of labour
A
- regular and painful uterine contractions
- a show (shedding of mucous plug)
- rupture of the membranes (not always)
- shortening and dilation of the cervix
3
Q
Stages of labour
A
Stage 1: from the onset of true labour to when the cervix is fully dilated
Stage 2: from full dilation to delivery of the fetus
Stage 3: from delivery of fetus to when the placenta and membranes have been completely delivered
4
Q
What do you monitor in labour?
A
- FHR monitored every 15min (or continuously via CTG)
- Contractions assessed every 30min
- Maternal pulse rate assessed every 60min
- Maternal BP and temp should be checked every 4 hours
- VE should be offered every 4 hours to check progression of labour
- Maternal urine should be checked for ketones and protein every 4 hours
5
Q
What is the normal delivery position?
A
The head normally delivers in an occipito-anterior position
6
Q
When is instrumental delivery indicated?
A
If longer than 1 hour (can be left longer if epidural) consider Ventouse extraction, forceps delivery or caesarean section
7
Q
What is the indication for elective c-section?
A
Breech
>2 previous CS
maternal request
8
Q
Indication for emergency c-section
A
- Foetal distress
- Failure to progress
- cord prolapse
- footling breech
9
Q
Indications for induction of labour
A
- prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
- prelabour premature rupture of the membranes, where labour does not start
- diabetic mother > 38 weeks
- pre-eclampsia
- rhesus incompatibility
10
Q
what score is used to induce labour?
A
Bishop score
11
Q
Methods of induction of labour
A
- membrane sweep
- vaginal prostaglandin E2 (PGE2)
- maternal oxytocin infusion
- amniotomy (‘breaking of waters’)
- cervical ripening balloon
12
Q
Define HTN in pregnancy
A
systolic > 140 mmHg or diastolic > 90 mmHg
- -> No proteinuria, no oedema
- -> Resolves following birth (typically after one month).
13
Q
Management of pregnancy induced HTN
A
- methyldopa, labetalol, nifedipine
- -> Severe HTN: IV hydralazine or labetalol
–> Contraindications: ACEi, ARB, Thiazide-like diuretic
- Aspirin 75mg od from 12 weeks until the birth of the baby for HIGH RISK GROUP
14
Q
Who are at high risk of developing pre-eclampsia?
A
- hypertensive disease during previous pregnancies
- chronic kidney disease
- autoimmune disorders such as SLE or antiphospholipid syndrome
- type 1 or 2 diabetes mellitus
15
Q
What is pre-eclampsia?
A
Pregnancy-induced hypertension in association with proteinuria
16
Q
Classic signs of pre-eclampsia
A
- Proteinuria
- High BP
- Oedema
17
Q
Other signs & symptoms of pre-eclampsia
A
- Headache and visual disturbance (floaters)
- RUQ pain (liver)
- Acute onset oedema
- Hyper-reflexia (brisk reflexes) & clonus
18
Q
Management of pre-eclampsia
A
Control BP
- refer to maternity unit
19
Q
Post-partum management of pre-eclampsia
A
- Remains at risk of eclampsia despite delivery (first 5 days)
- Continue antihypertensives for 1-2weeks –> GP weans off medications
20
Q
What is eclampsia?
A
Grand mal seizures in a woman with preeclampsia
21
Q
Management of eclampsia
A
emergency delivery of baby
22
Q
Symptoms of ectopic pregnancy
A
- Severe lower abdominal pain – usually unilateral
- PV bleeding
- Vomiting
23
Q
Symptoms of ruptured ectopic pregnancy
A
- Shoulder tip pain
- Feeling faint/light-headed
- Collapse
24
Q
Investigation for ectopic pregnancy
A
Diagnostic = Transvaginal USS
25
Management of ectopic pregnancy
1. Medical – Methotrexate
- -> Stops development of pregnancy
2. Surgical – Salpingectomy
- -> Removal of fallopian tube containing the ectopic pregnancy
- -> Usually laparoscopic unless haemodynamically unstable
26
What is the most common cause of severe infection in neonates?
Group B Streptococcal disease (GBS)
27
What is gestational diabetes?
High blood sugars that develop during pregnancy and usually disappears after delivery.
28
Screening for gestational diabetes
Oral glucose tolerance test
- fasting glucose is >= 5.6 mmol/L
- 2-hour glucose is >= 7.8 mmol/L
29
Management gestational diabetes
1. plasma glucose < 7 mmol/l = trial of diet and exercise
2. if target not met within 1-2 weeks = start metformin
3. if targets still not met = start insulin with metformin + exercise
4. plasma glucose > 7 mmol/l insulin
30
Targets for self monitoring
Fasting = 5.3 mmol/l
1 hour after meals = 7.8 mmol/l, or:
2 hour after meals = 6.4 mmol/l
31
Abortion time frame
<24 weeks – can be maternal choice
>24 weeks if risk to maternal or foetal health
32
Medical TOP:
At how many weeks?
What medication?
Less than 9 weeks = mifepristone (an anti-progestogen) followed 48 hours later by prostaglandins to stimulate uterine contractions
33
Surgical TOP:
At how many weeks?
What method?
1. less than 13 weeks: surgical dilation and suction of uterine contents
2. more than 15 weeks: surgical dilation and evacuation of uterine contents or late medical abortion (induces 'mini-labour')
34
Define abruptio placenta
Separation of a normally sited placenta from the uterine wall
--> resulting in maternal haemorrhage into the intervening space
35
Clinical features of abruptio placenta
* pain constant + PVB *
- shock out of keeping with visible loss
- tender, tense uterus
- normal lie and presentation
- foetal heart: absent/distressed
- coagulation problems
- beware pre-eclampsia, DIC, anuria
36
Investigations in abruptio placenta
FBC + USS
37
Management of abruptio placenta
1. Urgent referral
2. Foetus alive and < 36 weeks
- foetal distress: immediate caesarean
- no foetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation
3. Foetus alive and > 36 weeks
- foetal distress: immediate caesarean
- no foetal distress: deliver vaginally
4. Foetus dead
- induce vaginal delivery
38
Maternal complications of abruptio placenta
1. shock
2. DIC
3. renal failure
4. PPH
39
Foetal complications of abruptio placenta
Hypoxia
| Death
40
Define placenta praevia
placenta lying wholly or partly in the lower uterine segment
41
Clinical features of placenta praevia
1. shock in proportion to
2. visible loss
3. no pain
4. uterus not tender
5. lie and presentation may be abnormal
6. fetal heart usually normal
7. small bleeds before large
42
Investigations for placenta praevia
Usually picked up on 20- week USS
| --> transvaginal USS (improves accuracy on placental localisation)
43
Management of low-lying placenta at 20 week scan
1. Rescan at 34 weeks
2. if placenta praevia at 34 weeks, scan every 2 weels
3. final USS at 36-37 week to determine method of delivery
- grades III/IV = elective c-section between 37-38 weeks
- if grade I = vaginal delivery
- if in labour prior to elective c-section, then emergency c-section due to risk of PPH
44
Management of placenta praevia with bleeding
1. Admit
2. ABC approach to stabilise the woman
3. if not able to stabilise → emergency caesarean section
4. if in labour or term reached → emergency caesarean section
45
Define Postpartum haemorrhage (PPH)
blood loss of > 500mls
46
Types of PPH
Primary: occurs within 24 hours
Secondary:
occurs between 24 hours - 12 weeks
47
Symptom of PPH
Uncontrolled PV bleeding
48
Causes of PPH
1. Tone - Uterine atony (failure of uterus to contract down post delivery) (primary)
2. Trauma - perineal trauma (primary)
3. Tissue - retained placenta (secondary)
4. Thrombosis- clotting disorder (primary)
49
Management of PPH
1. ABC including two peripheral cannulae, 14 gauge
2. IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
3. IM carboprost
4. if medical options fail to control the bleeding then surgical options
4. intrauterine balloon tamponade (1st line ) = uterine atony
5. other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
6. if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure
50
Define premature rupture of membranes
Rupture of the amniotic sac prior to the commencement of labour.
51
Investigation for PROM
Speculum examination
| Pelvic USS
52
Management of PROM
1. Admission
2. regular observations to ensure chorioamnionitis is not developing
3. oral erythromycin should be given for 10 days
4. antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
5. delivery should be considered at 34 weeks of gestation
53
What is Rh incompatability?
Rhesus sensitisation
- When a mothers Rh-ve blood mixes with foetal Rh+ve blood
- Mothers immune system develops antibodies against Rh+ve RBCs
This may lead to haemolytic disease of the new-born in future pregnancies:
- -> If in their next pregnancy the foetus is Rh+ve
- -> Antibodies attack RBCs -> haemolytic anaemia & neonatal jaundice
54
What tests need to be carried out in rh incompatability?
1. all babies born to Rh -ve mother should have *cord blood* taken at delivery for FBC, blood group & direct Coombs test
2. Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
55
Management of rh incompatability
Prophylactic anti-D at 28 & 34/40 + if any bleeding antenatally
56
Features for rh incompatibility in affected foetus
1. oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls)
2. jaundice, anaemia, hepatosplenomegaly
3. heart failure
57
What is shoulder dystocia?
1. complication of vaginal cephalic delivery.
| 2. inability to deliver the body of the foetus using gentle traction, the head having already been delivered.
58
Risk factors for shoulder dystocia
1. Previous shoulder dystocia
2. Diabetes
3. BMI >30
4. Macrosomia (large baby)
59
Management of shoulder dystocia
1. Senior help should be called as soon as shoulder dystocia is identified
2. McRoberts' manoeuvre should be performed:
this manoeuvre entails flexion and abduction of the maternal hips, bringing the mother's thighs towards her abdomen
3. An episiotomy will not relieve the bony obstruction but is sometimes used to allow better access for internal manoeuvres.
5. C-section
60
Complications of shoulder dystocia
maternal
- postpartum haemorrhage
- perineal tears
fetal
- brachial plexus injury
- neonatal death
61
What are the risk factors for ovarian cancer?
- Family hx of BRCA1/2 gene mutation
| - many ovulations: early menarche, late menopause, nulliparity
62
Clinical features of ovarian cancer
Usually vague:
- abdo distension + bloating
- abdo + pelvic pain
- urinary symptoms (urgency)
- early satiety
- diarrhoea
63
Investigations for ovarian cancer
1. CA125 test
- -> raised: urgent USS of abdo + pelvis
- -> usually raised in endometriosis, menstruation, ovarian cysts
2. Diagnostic laparotomy
64
Management of ovarian cancer
Combo of surgery and platinum-based chemotherapy
65
What is breast abscess?
localized collection of pus within the breast
| - more common in lactating women
66
Features of breast abscess
1. Red, hot tender swelling
| 2. O/E : tender fluctuant mass
67
Diagnosis of breast abscess
USS
68
Treatment for breast absecess
Abx + USS guided aspiration
69
What are breast fibroadenoma?
1. Breast tissues are arranged into lobules which are milk secreting glands
2. Fibroadenomas occur due to increase in size of these milk secreting glands.
3. Fibroadenomas are benign breast tumours that are thought to occur due to hormonal fluctuations.
70
Features of breast fibroadenoma
Mobile, firm, smooth, non-tender breast lump - a 'breast mouse'
71
Management of breast fibroadenoma
- Referral to breast clinic
- Usually self-limiting
>3cm = surgical excision
72
Investigations for breast fibroadenoma
USS if pt < 40, mammogram & needle biopsy
73
Features of fibrocystic disease
- 'Lumpy' breasts which may be painful.
| - Symptoms may worsen prior to menstruation
74
Investigations for fibrocystic disease
USS/ mammogram if suspecting breast cancer
75
Management for fibrocystic disease
Conservative : Pain relief
76
What is mastitis?
Mastitis is a painful inflammatory condition of the breast.
| --> usually occurs in lactating women
77
Features of mastitis
1. A painful breast.
2. Fever and/or general malaise.
3. A tender, red, swollen, and hard area of the breast, usually in a wedge-shaped distribution.
78
Investigations for mastitis
send a sample of breast milk for microscopy, culture, and antibiotic sensitivity
79
1st line management of mastitis
continue breastfeeding
80
When is abx indicated in mastitis?
1. if systemically unwell
2. if nipple fissure present
3. if symptoms do not improve after 12-24 hours of effective milk removal
4. if culture indicates infection'
81
What abx is given in mastitis?
1st line = flucloxacillin for 10-14 days
Allergic to penicillin: erythromycin
82
What is the most common infective organism in mastitis?
Staphylococcus aureus
83
Complication of mastitis if left untreated
Develop into breast abscess
84
Clinical features of breast cancer
1. breast lump
- Malignant --> painless
2. Nipple symptoms: change in shape or bleeding
- -> Tethering or peau d’orange
- -> Unilateral discharge, retraction
85
Investigations for breast cancer
Mammography and core biopsy
86
What is the 2 - week wait referral indication for breast cancer?
1. >30 y/o + unexplained breast lump with or without pain
or
2. > 50 y/o + unilateral discharge/retraction
87
What other symptoms which consider 2WW
1. with skin changes that suggest breast cancer
or
2. > aged 30 with an unexplained lump in the axilla
88
Non-urgent referral indication for breast cancer
< 30 y/o with an unexplained breast lump with or without pain.
89
Treatment for breast cancer
1. Wide local excision or mastectomy
| 2. Chemo or radiotherapy
90
What is pelvic inflammatory disease?
sudden or severe inflammation of the womb, fallopian tubes, ovaries and surrounding areas in the lower abdomen
91
Features of PID
1. lower abdominal pain
2. fever
3. deep dyspareunia
4. dysuria
5. menstrual irregularities may occur
6. vaginal or cervical discharge - purulent
7. cervical excitation
92
Investigation for PID
1. pregnancy test - exclude pregnancy
2. high vaginal swab
3. screen for chlamydia + gonorrhoea
Diagnosis is usually clinical
93
Management of PID
1st line:
- -> IM ceftriaxone 1g stat
- -> Doxycycline 100mg bd 14 days + Metronidazole 400mg bd 14 days
2nd line:
Ofloxacin 400mg bd + Metronidazole 400mg BD 14 days.
Small delay in treatment causes large increase in risk subfertility and ectopic pregnancy
94
What is menorrhagia?
excessive blood loss with regular menstruation (>80ml)
95
Common causes of menorrhagia
no underlying pathology - dysfunctional uterine bleeding
anovulatory cycles : chaotic cycles common at extremes of reprodutive life
fibroids
Hypothyrodism
PID
96
Investigations for menorrhagia
FBC
routine transvaginal US if sx like pelvic pain, intermentrual or post-coital bleeding
97
Management options for menorrhagia
Requires contraception:
- IUS (Mirena) first-line
- COCP
Does not require contraception:
- mefanamic acid / tranexamic acid
98
Is it necessary to measure blood loss to diagnose menorrhagia?
NO
99
What is endometritis?
infection or inflammation of the endometrium, the inner lining of the uterus
100
When is endometritis a common problem?
during pregnancy as bacteria can easily reach the uterus during childbirth
101
Sx of endometritis
- abnormal vaginal bleeding
- dyspareunia
- fever
- abdominal swelling
- lower abdominal pain / discomfort
102
Causes of endometritis
- normal vaginal bacteria
| - STI
103
How is endometritis tested for
- blood cultures
- FBC
- MSU
- high vaginal swab
- endometrial biopsy is diagnostic but rarely appropriate
104
Management of endometritis
clindamycin and gentamicin combined
105
What is urogenital prolapse
descent of one of the pelvic organs resulting in protrusion on the vaginal walls
106
Risk factors of urogenital prolapse
- increasing age (commonly post-menopausal women)
- multiparity
- obesity
- spina bifida
107
Sx of urogenital prolapse
```
pressure, heaviness, ' bearing-down'
urinary sx (incontinence, frequency and urgency)
```
108
Management of asymptomatic/mild prolapse
none needed
| conservative: weight loss, pelvic floor excercise
109
Management of symptomatic urogenital prolapse
ring pessary
| surgery (hysterectomy / sacrohysteropexy)
110
adenomyosis vs endometriosis
The difference between these conditions is where the endometrial tissue grows. Adenomyosis: Endometrial tissue grows into the muscle of the uterus. Endometriosis: Endometrial tissue grows outside the uterus and may involve the ovaries, fallopian tubes, pelvic side walls, or bowel.
111
What is endometriosis?
growth of ectopic endometrial tissue outside of the uterine cavity
112
clinical features of endometriosis
- chronic pelvic pain
- secondary dysmenorrhoea (pain often days before bleeding)
- deep dyspareunia
- urinary sx
113
Gold standard investigation for endometriosis
laparoscopy
114
treatment for symptomatic relief of endometriosis
NSAIDs +/- paracetamol (first-line)
| Hormonal (COCP/Progestogens)
115
Features of adenomyosis
dysmenorrhoea
menorrhagia
enlarged, boggy uterus
116
management of adenomyosis
GnRH agonists
| hysterectomy
117
What is a leimyoma also known as
fibroids
118
What is leimyoma
benign smooth muscle tumours of the uterus
119
epidemiology of leimyoma
more common in afro-carribean, rare before puberty
120
sx of leimyoma
- may be asymptomatic
- menorrhagia
- lower abdo pain
- bloating
- urinary sx e.g frequency
- subfertility
polycythaemia (rare)
121
how is leimyoma diagnosed
transvaginal US
122
treatment of asymptomatic fibroids
none-
| periodic review to monitor size and growth
123
management to shrink fibroids
GnRH agonists
surgical
- myomectomy (if woman wishes to conceive in future)
- hysterectomy
124
Risk factors for endometrial cancer
- obesity
- nulliparity
- early menarche
- late menopause
- PCOS
- Diabetes
- tamoxifen
125
Features of endometrial cancer
- postmenopausal bleeding
| - change in inter-menstraul bleeding in premenopausal
126
When should a patient be referred under the cancer pathway for suspected endometrial cancer?
women >= 55 years who present with postmenopausal bleeding
127
First line investigation for endometrial cancer
transvaginal US
Other investigations:
- hysteroscopy with endometrial biopsy
128
Management of endometrial cancer
localised disease :
total abdominal hysterectomy with bilateral salpingo-oophorectomy
- may have post-op radiotherapy
not suitable for surgery
- progestogen therapy
129
Which factors are considered protective in endometrial cancer
COCP and smoking
130
Symptoms of cervicitis
- purulent yellow/green discharge
- intermenstrual / postcoital bleeding
- dysuria
- Pelvic pain
131
main cause of cervicitis
STI
132
management of cervicitis
depends on causative organism
133
What is cervical dysplasia
abnormal growth of cells on the surface of the cervix
134
The primary cause of cervical dysplasia
HPV
135
Risk factors of cervical dysplasia
multiple sexual partners
smoking
immunocompromised
136
symptoms of cervical dysplasia
usually asymptomatic
| - genital warts can indicate exposure to certain types of HPV
137
How is cervical dysplasia diagnosed
smear - cervical screening programme , HPV first system
138
What is the HPV first system?
sample tested for high-risk strains for HPV first and cytological examination performed if positive
139
What happens if hrHPV is negative?
return to normal recall
140
Positive hrHPV + abnormal cytology. What should you do next?
colposcopy
141
hrHPV +ve but cytologically normal- next steps?
repeat test in 12 months
142
inadequate hrHPV sample? - next step
repeat sample in 3 months
143
2 consecutive inadequate hrHPV samples - next step?
colposcopy
144
treatment of CIN
Large loop excision of transformation zone (LLETZ)
145
What is cervical insufficency / incompetent cervix
weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy
146
Sx of incompetent cervix
discharge during pregnancy
usually asymptomatic
premature labour
147
How is incompetent cervix diagnosed
transvaginal US
148
what is a nabothian cyst
small bump or bumps on the cervix caused by a build-up of normal mucus that is produced by the cervix
149
How is a nabothian cyst diagnosed
pelvic exam
transvaginal US
150
How is a nabothian cyst treated
none necessary
151
Symptoms of vaginitis
- itchy, sore vagina
- vaginal discharge
- vaginal dryness
- dysuria
- dyspareunia
- spotting
152
causes of vaginitis and sx associated to each
```
thrush - white thick discharge
STI - green/yellow/smelly discharge
menopause (hormonal) - dry, itchy
skin condition (eczema) - itschy, sore patches
```
153
investigation for vaginitis
pelvic examination and STI screen
154
management of vaginitis
depends on cause
- antifungal for thrush
- abx for STI
- vaginal lubricant
- hormone tx
- steroid medication for derm
155
Most common cause of vaginal neoplasm
HPV
156
Vaginal neoplasm sx
- lump in vagina
- ulcers and skin changes
- post-menopausal bleeding
- intermenstrual bleeding
- post-coital bleeding
- dyspareunia
157
management of women with an unexplained palpable mass in or at the entrance to the vagina
2WW referral
158
What is a cystocele
when the wall between the bladder and the vagina weakens (bladder prolapse)
159
sx of cystocele
- feeling of a vaginal bulge / pressure
- frequent voiding
- increased urgency
- urinary incontinence
- freuqnet UTI
160
major cause of cystocele
- multiparity
| - difficult childbirth
161
diagnosis of cystocele
- pelvic exam
- cytsoscopy
- MRI / US/ Xrays
162
management of cystocele
- none if asymptomatic
- kegel exercise (pelvic floor)
- pessary
- oestrogen replacement therapy
- surgery
163
What is a rectocele
tissues between the rectum and vagina weaken, causing the rectum to bulge into the vagina - posterior vaginal prolapse
164
rectocele sx
may include pelvic, vaginal and rectal pressure
165
risk factors of rectocele
multiparity, age, obesity, chronic constipation
166
management of rectocele
bowel training
| surgery
167
What is a Bartholin's cyst
small fluid-filled sac just inside the opening of the vagina
168
sx of Bartholin's cyst
soft, painless lump
usually only noticeable and uncomfortable after growth
- pain when walking
- pain during sex
169
What causes Bartholin's cyst
Bacterial infections / STI which clog the bartholin gland
170
diagnosis of Bartholin's cyst
- examination
- bacterial swab
- biopsy if ?Bartholin gland cancer
171
epidemiology of Bartholin's cyst
sexually active women aged 20 to 30
172
Management of Bartholin's cyst
- warm compress
- analgesia
- abx / drainage if infected
173
Define Dysmenorrhoea
excessive pain during the menstrual period
174
How is dysmenorrhoea divided?
primary - no underlying pelvic pathology
secondary - underlying pathology including:
endometriosis
PID
fibroids
175
features of primary dysmenorrhoea
- pain before/ within few hours of periods starting
| - suprapubic cramping pain radiating to back / thigh
176
Management of primary dysmenorrhoea
First line: NSAIDs (mefenamic acid / ibuprofen)
COCP
177
Management of secondary dysmenorrhoea
refer to gynae
178
Which phase of the menstrual cycle does PMS occur
luteal phase - after ovulation (when your ovaries release an egg) and before your period starts. During this time, the lining of your uterus normally gets thicker to prepare for a possible pregnancy.
179
sx of premenstrual syndrome
emotional:
- anxiety
- stress
- fatigue
- mood swings
physical:
- bloating
- breast pain
180
management of PMS
mild : lifestyle (sleep, exercise, healthy diet)
moderate sx: COCP
severe sx: SSRI
181
Define Primary Amenorrhea
failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development)
or by 13 years of age in girls with no secondary sexual characteristics
182
Define secondary Amenorrhea
cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea (irregular periods)
183
initial investigations for amenorrhoea
- EXCLUDE PREGNANCY
- FBC
- TFT
- coeliac screen
- gonadotrophins (low = hypothalamic cause, high = ovarian problem)
- prolactin
- androgen level (high in PCOS)
- oestradiol
184
management of amenorrhoea
treat underlying cause
HRT if gonadal dysgenesis
185
3 main features of PCOS
- irregular periods
- excess androgen (excess facial / body hair)
- polycystic ovaries
- sub/infertility
- obesity
186
Why might a woman with PCOS have acanthosis nigricans
insulin resistance is commonly seen with PCOS
187
investigations for PCOS
- Pelvic US : multiple cysts
- fsh, LH, (LH:FSH raised)
- prolactin normal/mildly elevated
- TSH
- testosterone normal/mildly elevated
- check for impaired glucose tolerance
188
management of PCOS
- COCP to regulate periods and hirsutism
- weight reduction
- cyclical progestogen for amenorrhoea
189
Which supplement should be given to pregnant women, why and until when
folic acid until 3 months to reduce risk of neural tube defects (spina bidifda)
190
Which vaccination should a pregnant woman have if they havent already had it?
MMR
191
Which anti-epileptic medication should be switched in pregnancy
sodium valproate
